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Curing Hepatitis C: A Success Story and a Price Tag

Most people know about hepatitis B; babies get vaccinated for it at birth. But fewer people know about hepatitis C. C is actually more common than B, but most chronically infected people don’t know they have it. You might think ignorance is bliss, but patients who have no symptoms today may have liver cancer or a liver transplant in their future. Until recently, treatment for this stealth disease was disappointing, but according to three recent, large controlled studies published in The New England Journal of Medicine, the virus has been tamed. A short course of a new antiviral drug with few side effects was 99% effective in removing the virus from the blood.

History

In the beginning, there was jaundice. Patients turned yellow, developed flu-like symptoms, and sometimes died. Eventually doctors figured out that jaundice was a sign of liver disease and the condition was named hepatitis; and by the time I graduated from medical school in 1970, scientists had identified two viruses that caused infectious hepatitis: hepatitis A and B. Hepatitis A infection was transmitted by the fecal-oral route, usually by contamination of food; hepatitis B was transmitted by needles and blood products. Prevention was limited to good hygienic practices; treatment of acute hepatitis was limited to bed rest, supportive care, and IV fluids. Contacts could be given gamma globulin. In fulminant cases and chronic hepatitis, steroids were used. No treatment was very effective. Death and cirrhosis often ensued.

Non-C hepatitis today

Fast forward to 2014. Scientists have identified five hepatitis viruses: A, B, C, D, and E, along with numerous serotypes and genotypes. Antigen and antibody tests are available for accurate diagnosis.

Hepatitis A still infects 1.4 million people and kills around 100,000 people around the world every year. There is still no specific treatment available. A vaccine is available, but hygiene, sanitation, and food safety precautions are the mainstays of prevention.

Hepatitis B has infected about a third of the world’s inhabitants, and an estimated 350 million people are chronic carriers. The disease is transmitted through blood, sexual intercourse, semen, saliva, and childbirth. Chronic disease can lead to cirrhosis and causes about half of all liver cancers. The virus was first seen with an electron microscope in 1970, and by the early 1980s its genome had been sequenced. By 1991 an effective vaccine was being recommended for all infants at birth. Early vaccination is important because young children are particularly vulnerable. Only 5% of newborns infected by their mother will clear the infection, and they have a 40% lifetime risk of cirrhosis and liver cancer. Acute infection in older children and adults usually clears spontaneously, but treatment of chronic infection is necessary to prevent cirrhosis and liver cancer. Five antiviral drugs and two immune system modulators (interferons) are available; they don’t cure the infection but they reduce replication and liver damage.

Hepatitis D occurs only in those also infected with HBV, and it increases the risk of complications.

Hepatitis E infects 20 million people a year and causes 57,000 deaths. It’s more common in developing countries, and there are animal reservoirs. Vaccines have been developed but are not licensed in the US due to the low risk of infection in developed countries.

Hepatitis C

Hepatitis C was identified in 1989. It has been found in humans and chimpanzees and is transmitted by intravenous drug use, tattoos, transfusions and other exposures to blood, and by sexual intercourse. Only 15% of patients develop symptoms, but the virus persists in the liver in 85% of those infected; it causes 27% of all cirrhosis cases and 25% of all liver cancers, and is the number one reason for liver transplants. No vaccine is available. More than 3 million Americans are infected, and most of them don’t know it. 75% of cases are in baby boomers, so the CDC recently recommended a one-time screening blood test for those born between 1945 and 1965. Patients with positive tests are monitored with ultrasound, vaccinated against hepatitis A and B, and warned to avoid alcohol and hepatotoxic drugs.

Treatment

The first study of a treatment for hepatitis C was published in 1986, when it was still known only as “non-A non-B hepatitis.” It was a small pilot study (10 patients); treatment with interferon normalized liver function tests, but when treatment was discontinued, patients relapsed. Eventually, an interferon/ribavirin combination became the standard treatment; they were given for 24 or 48 weeks. Cure rates varied from 45% to 80% depending on the HCV genotype. Interferon is contraindicated in patients with certain medical conditions, and serious side effects are common. A systematic review in 2013 showed that a sustained virologic response reduced the risk of liver cancer by 75%. Despite the availability of treatment, the mortality rate from hepatitis C continued to increase until it exceeded the rate for HIV infection.

The new studies

Newer antiviral agents were developed. Three new studies of the combination of ledipasvir and sofosbuvir were published in April of 2014. They were large, randomized open-label studies comparing different antiviral regimens. Placebo controls would have been unethical, since that would have denied subjects the known benefits of treatment.

A four-arm study by Afdhal et al. of 865 previously-untreated patients found high response rates: ledipasvir and sofosbuvir for 12 weeks produced a sustained virologic response in 99% of subjects; for 24 weeks, 98%; with ribavirin added, the rates were 97% after 12 weeks treatment and 99% after 24 weeks.

A similar four-arm study by Afdhal et al. enrolled 404 patients who had already failed treatment with peginterferon and ribavirin. It showed similar results (96-99% response rates).

A study by Kowdley et al. of 647 previously-untreated patients found that 8 weeks treatment with lepipasvir and sofosbuvir was as good as 12 weeks, and adding ribavirin did not improve response.

Virologic response was defined as the absence of quantifiable HCV RNA in serum (less than 25 IU/ml). Side effects were mild, including fatigue, headache, and nausea; no subject in any of these studies had to discontinue treatment because of side effects. The medication was given as a convenient, once-daily pill.

Considering the typical response rates in published studies, these results are astounding. It appears that simply taking a single pill once a day for 8 weeks will safely and effectively protect patients from liver failure and liver cancer. Further studies will be needed to show whether death and transplantation rates will actually decrease, but there is very good reason to expect that they will.

High price tag

There’s only one problem: sofosbuvir pills alone cost $1,000 each, or $84,000 for a 12-week course of treatment; and the addition of ledipasvir will add to the costs. Can society afford the billions of dollars needed to identify and treat everyone at risk? Will we revisit the early days of dialysis when “death panels” rationed treatment and decided which lives were worthy of saving? Today, dialysis is more effective, less expensive, more readily available, and is covered by Medicare for patients of all ages. We solved that problem, and I am optimistic that we will solve the hepatitis C problem as well.

Alternative treatments

Several alternative medicine options have been recommended for the treatment of hepatitis C, including milk thistle, licorice root, ginseng, thymus extract, zinc, SAMe, colloidal silver, probiotics, shisandra, TJ-108 (an herbal mixture used in Japanese Kampo medicine), massage, chiropractic care, and relaxation techniques. The NIH has reviewed the scant available evidence. There is evidence that some of these don’t work, and some of them have not been studied at all. There have been a few mildly positive but questionable studies; but certainly nothing that could even begin to compete with the kind of results achieved in the NEJM studies.

Conclusion

The new antiviral treatments for hepatitis C are a great example of science-based medicine in action. We can anticipate that they will save a lot of lives, especially if the economic problems can be overcome.

Posted in: Clinical Trials, Pharmaceuticals

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31 thoughts on “Curing Hepatitis C: A Success Story and a Price Tag

    1. PMoran says:

      Good to see pieces like this, Harriet. Various attempts at demonizing CAM have not been obviously very successful in dampening its more unwise uses. Those at risk may need to be constantly reminded how, and where, a science-based approach does (at least eventually, sometimes slowly) produce better outcomes.

      I suppose those offering venture capital for risky projects deserve a healthy return on investment (how much is applyiing here?), and taxpayers cannot afford to be buying out every new drug, but I agree with Windriven that it still feels somehow wrong.

    2. Calli Arcale says:

      Part of this makes me wonder whether the traditional government contracting model might be applied here. Everybody says government contracting is so fraudulent, but in fact there is a truly exorbitant amount of auditing to protect against fraud. (Which, of course, raises the cost. But look at drug prices and ask whether the price would be any better without all that?)

      If the government directly funded new drug development, it would enjoy unlimited rights to the intellectual property and could license to whomever it pleased. The contractor who developed it wouldn’t want someone else to get to make it, but would enjoy less personal risk since they didn’t have to front the development costs. And perhaps then the the government could hold licensing as a threat — if the contractor decides to charge too much for it, the government will issue the license to others. That’s basically what the government already does with, for instance, torpedo manufacturers. Start charging too much per unit, and they go find another manufacturer and license the tech to them. Because the government absolutely can do that if it wants. To make sure the option of generics exists, the government could give a window of time comparable to the window for patent protection before it becomes freely licenseable.

      But it would require more government funding go into medical research. And under the current fiscal climate, I’m sure that’ll go over *real* well. Plus, the government doesn’t really have a program office accustomed to that market. Wanna develop new electronic gizmos for naval airplanes? Ask PMA-209 (part of NAVAIR) to issue a request for proposals. They know that stuff backwards and forwards and even develop stuff themselves, so they know when a contractor is blowing smoke. Do we have anything comparable that could have adequate oversight over a new drug development program? I don’t think so, and getting it wrong could be not just costly, but tragic.

      1. Windriven says:

        “But it would require more government funding go into medical research. And under the current fiscal climate, I’m sure that’ll go over *real* well.”

        Perhaps, but it is all a question of priorities. The US spends roughly 18% of GDP on health care – at least half again as much per capita as other industrialized nations. Pharma consumes right at 10% of that. Call it $380 billion per year. So, using back of an envelope math about a third of that – $114 billion – is wasted (expense greater than than paid by peer nations).

        NIH has a budget of a shade over $29 billion. If we captured just half of that $114 billion that would almost triple the NIH budget to $86 billion dollars. Compare that to the aggregate R&D of the 10 largest Pharma companies which Fierce Biotech puts at about $70 billion and it becomes clear that we could do this without spilling too much blood. Yes, Pharma would squeal like a scalded cat. But they’d still be selling at higher prices in the US than they get anywhere else. They’d be shedding risk but also forgoing gargantuan profits.

        You’re right. It would never work.

    3. MadisonMD says:

      This raises anew questions about drug research and marketing. The costs of drug development and testing are certainly large. But how much of the initial research was funded by NIH or other public mechanisms?

      This is an important observation. Yet, there is often no clear line of distinction between basic, applied, and commercial research. You can view the government as pushing things just far enough that private enterprise can take over, and at that point make large investments at large risk to establish a proven therapy and then deliver it to market.

      If the government directly funded new drug development, it would enjoy unlimited rights to the intellectual property and could license to whomever it pleased.

      An interesting actual example of this is Taxol which the government developed and proved effective, then licensed (with patent protection) to BMS. The US government apparently wasn’t ready to become a pharma company when it comes to procuring, synthesizing, and distributing GMP-manufactured drugs. (Also they had chopped down too many Pacific Yew since complete chemical synthesis wasn’t available until mid-90′s) They even gave away the trademark name Taxol to BMS.

      But it would require more government funding go into medical research.

      Yep. In the long view, all hepatitis C drugs and others will lose patent protection, so, in the long view, the current system provides us with proven effective treatments, risk taken on by private industry, and a decade of exorbitant costs for each new drug (too long if you need it; too short if you need the money to invest in the next drug being developed). Which makes me wonder if our current system is the worst one except for all the others.*

      *Credit to where its due.

      1. Windriven says:

        “Which makes me wonder if our current system is the worst one except for all the others.”

        Fair enough, Madison. But American consumers of pharmaceuticals generally pay rather more for the privilege than Canadians, Germans, and Swedes*. This means that we are subsidizing pharmaceuticals for our peers – or the profits of Pharma shareholders – depending on your point of view.

        I am especially sensitive to the blurred line that you mention:

        “Yet, there is often no clear line of distinction between basic, applied, and commercial research.”

        But universities for instance have no compunction about claiming a share of the fruits of their research scientists, funded as you know by lots of federal and other monies.

        I am a capitalist at heart and I certainly don’t begrudge those who have taken a big risk and won, walking off with a big pile of f*ck you money. But I do object to not getting a lick of the ice cream cone if I** have contributed. And I object if the profit is exorbitant. When there is a disaster and some dick in a blue jumpsuit is charging $25 for a bag of ice, that is called gouging and in many jurisdictions he’ll face fines and/or a little jail time. But when the gouger is a CEO wearing an Armani suit and charging $80,000 for a jar of pills he’s called a captain of industry and people line up to kiss his a$$.

        So if that’s the worst we can do except all the others, I think we owe it another try.

        *I personally have no objection to subsidizing Bangladeshis, Sudanese, and the odd Yemeni.
        **Speaking now as a taxpayer

      2. Windriven says:

        Madison,
        A report in today’s Wall Street Journal is just what I’m talking about. Valeant is mounting a takeover bid for Allergan.

        “[Valeant CEO] Pearson is a serial acquirer known to take over companies for their products, cut away research spending and then try to boost revenue by moving the products through Valeant’s sales force.” Pearson is a billionaire as reported by Forbes Magazine. Not by creating valuable science. By cutting costs, gutting R&D, and pushing his salesforce to beat on Crislip’s door with cases of Fleet.

        Nothing matters except shareholder value. Makes me proud to be a capitalist.

      3. MadisonMD says:

        Yes, windriven, I am convinced. Unregulated capitalism is ugly. Teddy R. did something, but not enough. Even today, improvements can be made.

        I would feel better about it if pharma cut marketing, cut CEO/management salaries to reasonable levels, and plowed most profits into R&D.

        I’m at a University that has made big $ off licensing technologies based on research funded by government. At least *some* of that money has been reinvested in the university (buildings), recruiting/retaining faculty, and research– effectively supplementing federal funds for research. It effectively brings venture capital into the university. Yet, we know that there is a large trust is privately managed by a bunch of lawyers and businessmen and that a big chunk doesn’t go to the university. I have no idea what fraction is reinvested.

        1. Windriven says:

          “Teddy R.”

          I’m all for digging up his corpse, stuffing it with animatronics, and resurrecting the Bull Moose party.

          If you haven’t read Kearns Goodwin’s treatment of Roosevelt and Taft, I recommend it though I think she let TR off a little too easily on his breach with Taft.

  1. Alex says:

    One of my family members had hepatitis many years ago but doctors did not identify type of hepatitis. What could family member do now to obtain correct diagnosis? Doctor’s records from time of illness are not available.

    Thank you.

    1. Newcoaster says:

      There’s probably nothing that can be done if you don’t have access to the original medical records. Also, if this was “many years ago”…or at least prior to 1989, it’s very likely the doctors at the time didn’t know what it was….other than non-A/non-B.

      I guess my question would be why would it matter to you today?

      1. Alex says:

        To estimate risks of liver cancer today.

    2. Windriven says:

      “What could family member do now to obtain correct diagnosis? Doctor’s records from time of illness are not available.”

      First thing would be for the family member to discuss with his or her physician. The person could have a hep virus panel run and as I recall they aren’t particularly expensive. But the panel probably needs to be ordered by a physician to be covered by insurance – and to be certain the panel is run by a credible lab.

    3. MadisonMD says:

      Yep, a hepatitis panel can make the diagnosis of chronic hepatitis. It can also demonstrate prior exposure to a hepatitis that has been eliminated by the presence of antibodies. So your doctor can figure out if this was A, B, C, and eliminated versus chronic with a blood test.

      1. Daniel Duncan says:

        My parents recently had a scare of hepatitis b, when my dad showed antibodies on a blood donation screening. My mom had been exposed or vaccinated against it in the 80′s or early 90′s but when she was tested recently she showed no antibodies. She also has sarcoidosis, which she told me is an auto immune disease. What is the likelihood of such a case being a major health issue?

  2. MedsVsTherapy says:

    The cost is high. Their are rival drugs and regimens, so hopefully competition will lead to pressures to drop prices.

    Also, the status quo up to now, interferon-alpha plus ribavirin, has a much lower, but still hefty price tag – commenters here may know better numbers, but a while back it was said that IFN/ribavirin treatment was about $25,000, with the expected cure rate at 40% for the genotype most common in the U.S.

    The IFN regimen is difficult for many people, and so you have lost productivity during the treatment. For these new HCV treatments, I have not seen side effects or adverse events of the scale that you have with IFN.

    Discontinuation rates should be lower, leading to a greater portion of successful regimen completion. A lot of IFN treatment was wasted since patients had to discontinue due to side effects.

    So, the difference between $25,000 and $80,000 starts to look smaller when the eventual outcomes are examined.

    I definitely see this as a medical tourism deal. Round trip to India, at some place where the health insurance provider could ensure the patient would have safe food and drink so nothing threatened the liver, and maybe a nurse making hotel-room visits to ensure you receive and take your daily pills.

    If a health insurer would eventually be responsible for hepatocellur cancer and other long-term outcomes, the 80K versus 25K price tag might be worth it, and the medical tourism may certainly be worth it -

    I will over-simply some numbers from Afdhal’s 2004 overview: if a health insurer was covering 100 patients with chronic HCV, and decided they were under threat of disease advancing, and the patient not dying of some thing else in the meantime, here is how things might go: 20% might advance to serious cirrhosis, and of those, 25% might advance to liver cancer.

    This would be 5 of those 100 (25% of 20% of 100).

    HCV is the medical cause for about a tenth of all cases of liver-transplant need (old data: Jain 2000 annals of surgery- this could be quite different by now as the HCV problem has been a snowball in the making since the 1970s).

    So, I think there is a great opportunity for cost-benefit to the new therapies.

    Since it seems so darn reasonable to look at it this way, versus IFN treatment, it may be this is how the drug companies come up with their $80,000 price tag.

  3. Kiiri says:

    This was our problem in a cost benefit class I took. My group looked at the numbers for Hep C and did cost-benefit analysis based on different methods. It was cost effective to screen only if insurance covered treatment. I believe (and I don’t have the sources in front of me) we estimated the cost of liver transplant to be upwards of $300,000. And that was for the transplant, those people are then on drug therapy the rest of their lives. We did not have the numbers for the new treatment but did estimate that even a much higher price tag than interferon ribaviarin could be cost effective in the long term. Of course convincing everyone of that is difficult. Although it may be easier to start talking to insurers about long term benefits now that they can’t bounce people off coverage for becoming ill, or deny them coverage based on pre-existing condition. I have heard anecdotally that people have declined hepatitis testing due to concerns of losing insurance if it is diagnosed.

  4. qetzal says:

    For whatever it’s worth, the high price isn’t hurting sales of sofosbuvir (Solvadi). Gilead sold $2.27 billion worth in the 1st quarter of this year, double what analysts expected! Gilead says about 30,000 patients have taken the drug already.

    See http://www.bloomberg.com/news/2014-04-22/gilead-beats-hepatitis-c-sales-estimates-by-1-billion.html.

  5. 14012783 says:

    The medical field again leaves me amazed at the amount of progress it makes in its research and application of treatments for illness and disease. I myself was not even aware of the existence of Hepatitis C before reading this article, not even to mention the extensive research done to find a possible treatment for this disease. I find it very interesting that Hepatitis C is more common than Hepatitis B and that one can be a carrier of Hepatitis C and not present any symptoms.
    The high number of people infected with Hepatitis C is explainable as many people are not aware that they are infected with the virus. However the large number of deaths reflected in the statistics on Hepatitis A and B is shocking. Living in a country where these vaccinations are readily available for free to parents of infants, I am left to question why people don’t make use of these services. I believe that not enough information is offered to the general public concerning the risks of hepatitis in all its forms. Also many parents believe that there are great risks involved when vaccinating their children. Misconceived ideas on possible side-effects of vaccinations may influence parents not to allow their children to be immunized. Through educational appeals, possible risks and misguided ideas about the Hepatitis vaccinations can be eliminated while benefits of these vaccines can be highlighted to public.
    I do hope that in the future more information would also be made available on Hepatitis C. This information should include the risks of living with untreated Hepatitis C, possible treatments and the benefits of these treatments. Costs of research and production of treatments against Hepatitis C should not outweigh future exploration of this virus. I also hope, that as mentioned, competition would increase in the pharmaceutical industry and this in return would cause price drops of possible drugs for treatment. All medical research, at first, is costly and development and production of new treatments are expensive, but the medical and pharmaceutical field ,in some cases, always seem to find alternatives at lower costs to make these drugs and treatments available for everyone to afford.

  6. Vicki says:

    As a side note, I had to argue with my doctor to get that one-time hepatitis C screening. I asked for it, and I think she looked at me (white, educated, middle-class) and thought that I didn’t look like I needed it.

    So I pointed out that the CDC recommended it because of my age/cohort, and she had the test run (and it came back negative, which was reassuring but unsurprising). This is the same doctor who knows my date of birth and has recommended other tests based purely on that, tests significantly less pleasant than having a little bit of blood drawn.

    Why will a doctor look at a new patient, see that she has just turned 50, and refer her for a colonoscopy and ask when she had her last mammogram, but have to be talked into the hepatitis C test? If she’d brought up the question and asked whether I’d ever been tested for this, like asking about the mammogram, that would have made sense. The whole point of the CDC recommendation is that you can’t look at someone in 2013 and know reliably whether they have done anything, some time in the past thirty years, that might have exposed them to hepatitis C, and “were you born between 1945 and 1964?” doesn’t rely heavily on patient memory.

  7. Frederick says:

    Very good article! I knew the existence of those diseases, I’m vaccinated from sthose who can be vaccinated ( twinrix). But i did not really know the differences between them. Nicely detailed article, Always good to learn more stuff.

  8. Ed Whitney says:

    The Hepatitis C randomized trials were registered with clinicaltrials.gov. As I expected, the study protocols specified the primary outcome of the studies, namely the proportion of participants with a sustained virologic response 12 weeks after cessation of therapy . I was surprised to see that none of the protocols specified what the researchers considered to be a minimal clinically important difference between groups (effect size) in the primary outcomes. The effect size the researchers are looking for is critically important in determining the sample size needed for the trial to answer the research question; its omission means that the research question is not well specified. Are there reasons for these omissions?

    It is not just Hepatitis C; it seems that trials for all kinds of condition are being registered without the investigators even saying how large a treatment difference in the primary outcome is being sought. If you do not know the study hypothesis, how do you know whether the study tested it properly?

    If you are comparing interventions A and B for their effects on outcome C, I would like to know how large a difference in outcome C you are expecting to find between interventions A and B. Are there reasons that investigators are not furnishing this information when they register their trials?

    What am I missing here?

    I will bet that some reader of this website knows the answer to this.

    1. Ed Whitney says:

      PS: The two trials published in the New England Journal that came online a few minutes ago were similar in having the prespecified primary outcome but no specification as to the minimal clinicallly important difference was being sought.

      1. Xplodyncow says:

        Is this information available in the “Supplementary Material” section (the protocol, maybe)? Not sure whether this link to the protocol for the Afdahl, Zeuzem, Kwo (et al) trial will help (or even work!): http://www.nejm.org/doi/suppl/10.1056/NEJMoa1402454/suppl_file/nejmoa1402454_protocol.pdf

        1. Ed Whitney says:

          The place I was actually looking for the minimal clinically important difference (MCID) was at http://clinicaltrials.gov/, where you can enter the registry number and find the protocol. This number is often given in the abstract (for Feld, it is NCT01716585 and is at the end of the abstract. Feld’s primary outcome was “Percentage of subjects with sustained virologic response 12 weeks post-treatment [SVR12]” but the MCID was not there.

          In the protocol at the NEJM website there is a statement that an SVR12 of at least 66% is required for declaration of success of treatment. The clinicaltrials.gov protocol had no such information.

          Clinicaltrials.gov only gets data collected by the FDA, and I am not sure whether the MCID is included in the protocols received by the FDA or not. Perhaps the investigators provide MCID data when they submit their protocols to the FDA and the FDA does not pass that information along to the clinicaltrials.gov website.

          The MCID certainly seems like important information and I remain surprised that the clinicaltrials.gov registry is not given this information, assuming that clinical trials registries are there to increase transparency of trial data.

  9. JimboJones says:

    I know anecdotes only go so far, however I am currently undergoing treatment with Sofosbuvir, Interferon, and Ribavarin. I am insured by an ok plan (not great) and was easily able to have it covered along with a very reasonable payment plan with little effort. Maybe the costs involved will come back to bite me in the ass, but I don’t think so. The biggest headache is the Sofosbuvir is required to be picked up weekly from the hospital 2 hours away-that’s what I get for living in the boonies. Not too bad for an incredibly high success rate and (in my case) low side effects. Cost benefit was something I of course considered, but didn’t need to for long. AND the fact that the previous treatments ran for 48 weeks, vs. the 12 weeks with this setup. Woo woo friends of mine tried to convince me otherwise, but my skeptical kung fu kept me on the right track. I for one am a happy, (almost) cured dude.

  10. Jill Rogat says:

    This is excellent information and I am pleased research is starting to yield positive results. One of my best friends has Hepatitis C and my brother-in-law recently found out he has it, too. Often the people who have it are unexpected.

  11. 13168152 says:

    I have worked in a government hospital in South-Africa a couple of years ago and now still working in a private hospital. We were scanned for Hepatitis B and C twice a year as it is a blood-borne disease and working in the hospitals chances do increase if one does not take all the correct precautionary measurements.

    It is really unnerving for me to know that, especially in a country like South-Africa were the number of people infected by HIV, TB and Hepatitis A (even though Hep A is not blood-borne or contagious) that decreases the immune-system, there is no vaccination available in our country for Hepatitis C (GEMS, 2013). Hepatitis C is also a disease that could become a chronicle illness which is alarming with all the other illnesses so prevalent already in our country.

    The cost of the treatment is astoundingly high, it’s actually quite scary to think how much it cost for a 12 week treatment, and I do hope more countries will invest in finding vaccines and treatments so the cost can be lowered and that it would be more affordable to treat and vaccinate for this disease that is more prevalent than what we are aware. It is important that more awareness of this disease increases of due to the fact that one can be a carrier of this disease without knowing this and that could lead to the spread of this disease.

    What I would like to know if one can see any scars or indication of the disease on a scans of the liver. Does this disease leave identifiable marks in the liver and when treated can the effects it already had on the liver be reversed?

    1. Andrey Pavlov says:

      (even though Hep A is not blood-borne or contagious)

      You are correct that it is not blood borne, but it is indeed very contagious.

      there is no vaccination available in our country for Hepatitis C

      There is no HepC vaccine available in any country as it does not exist.

      What I would like to know if one can see any scars or indication of the disease on a scans of the liver. Does this disease leave identifiable marks in the liver and when treated can the effects it already had on the liver be reversed?

      Only in more advanced stages, where the damage is permanent, can much be seen in the liver with ultrasound. The exception is fatty infiltrates, which can sometimes occur from hepatitis but more commonly from alcohol ingestion. Neither can be diagnostic of a specific etiology, as many things can cause similar looking finding. A liver biopsy is more sensitive and can detect damage that is not seen on ultrasound, though that damage will still be permanent, just less extensive.

      The better test is a blood test checking for the various viral components and/or immunoglobulins specific to the virus.

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